NCDR Study Finds Use of Prophylactic MCS Increasing in Elective PCI For Stable CAD Patients
Prophylactic mechanical circulatory support (MCS) use has increased for patients with stable coronary artery disease (CAD) undergoing elective PCI, according to a study published recently in Circulation: Cardiovascular Interventions.
Using data from ACC’s CathPCI Registry, Michel Zeitouni, MD, MSc, et al., investigated trends and outcomes associated with prophylactic MCS use, among 2,108,715 patients with stable CAD who had an elective PCI from 2009 to 2018. They also looked at the effectiveness and safety of intra-aortic balloon pump (IABP) use compared with other MCS.
Zeitouni, et al., found that a total of 6,905 patients (0.3%) underwent elective PCI with prophylactic MCS. Compared with patients who did not have MCS, they were older, more often men, and a higher history of a myocardial infarction, heart failure, diabetes, stroke or peripheral artery disease.
Results showed a trend for increasing use of MCS from 0.2% of elective PCI procedures in 2009 to 0.6% in 2018, primarily driven by MCS other than an IABP. Meanwhile, use of IABP remained low and constant over the decade. An increase in the number of hospitals using at least one MCS for this patient population rose from 279 to 514 from 2010 to 2017. The primary high-risk feature driving the use of prophylactic MCS was unprotected left main PCI, followed by use of atherectomy device and a left ventricular ejection fraction ≤30%.
The rate of in-hospital major adverse cardiac events (MACE) was 7.1% and cardiovascular complications was 18.8% with prophylactic MCS, compared with rates of 0.5% and 2.3% respectively without prophylactic MCS. Notably, an IABP, compared with other MCS, was associated with a higher risk of MACE (9.6% vs. 6.0%; adjusted odds ratio, 1.59; 95% CI, 1.32-1.91) but lower risk of complications (18.2% vs. 19.1%; adjusted odds ratio, 0.88; 95% CI, 0.77-0.99).
The authors write: “Despite the lack of evidence from randomized controlled trials, the use of prophylactic MCS is increasing over time to support elective PCIs, in clinical practice in the United States. However, they remain used in <1% of elective PCIs and are mostly represented by non-IABP MCS.” They add that moving forward, evidence is needed from randomized trials to better evaluate the use of MCS in high-risk PCI.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Coronary Artery Disease, Interventions and Vascular Medicine
Keywords: Shock, Cardiogenic, Randomized Controlled Trials as Topic, Diabetes Mellitus, Atherectomy, Heart Failure, Peripheral Arterial Disease, Hospitals, Stroke, Registries, Ventricular Function, Left, Odds Ratio, Coronary Artery Disease, Stroke Volume, Percutaneous Coronary Intervention, CathPCI Registry
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